Original Research

Five professional organizations in Europe and North America have published guidelines for using statins to prevent atherosclerotic cardiovascular disease. Application of the different guidelines to a single population aged 40 to 75 years would result in as few as 15% and as many as 44% of participants receiving statins. This study estimated how many cardiovascular events would be prevented using each guideline.

Limited data suggest high rates of unplanned rehospitalization after endovascular and surgical revascularization for peripheral arterial disease, but the overall burden of readmissions has not been comprehensively explored. This retrospective cohort study evaluated nationwide readmissions after peripheral arterial revascularization for peripheral arterial disease and to assess whether readmission risk varies among hospitals.

Whole-exome sequencing (WES) enables evaluation of protein-coding regions of the genome enriched for disease-associated gene variants. Although WES is emerging as a useful tool in the evaluation of pediatric disorders, little is known of its utility among adult patients. This study evaluated the utility of WES to assist in the diagnosis and management of adults with chronic kidney disease.

Ideas and Opinions

The opioid epidemic has garnered widespread attention and concern. Although evidence-based treatments for opioid use disorders exist, health system and regulatory barriers may limit their use. In this commentary, the authors discuss the need for further investigation into slow-release oral morphine as a potential treatment for patients with these disorders.

Cancer screening is often recommended to patients believed to have a specific risk factor, such as prostate cancer screening for men who have a family history of the disease or melanoma screening for those who have substantial sun exposure. But does such preferential screening inflate the importance of such risk factors?

Editorials

Mortensen and Nordestgaard applied guideline recommendations from respected groups to determine eligibility for statins for primary prevention of cardiovascular disease in 45 750 persons enrolled in the Copenhagen General Population Study. They then modeled the occurrence of atherosclerotic cardiovascular disease over 10 years. The editorialist discusses the findings and explains that the differences among guidelines reflect the priorities, preferences, local needs, and practical realities of intended users.

Mills and colleagues' meta-analysis assessed the comparative effectiveness of 8 implementation strategies for blood pressure control. The editorialists discuss the findings and speculate on why blood pressure control remains elusive 40 years after evidence documented that control improves patient outcomes.

Clinical use of checkpoint inhibitor (CPI) therapy for cancer has grown rapidly: 6 approved agents are increasingly being used for a broad array of tumors. Abdel-Wahab and colleagues' systematic review examined outcomes of patients with preexisting autoimmune disease who developed cancer and were treated with CPIs. The editorialist discusses the findings and highlights areas of immediate concern for the care of such patients.

On Being a Doctor

Part of being a doctor these days involves dealing with conflicts of interest in the health care system. I've always worried about my own conflicts of interest, whether in clinical care, education, or research.

How can we elevate the quality and efficiency of inpatient care? The authors of this commentary explain why it is time for radical, disruptive change in how we organize our patients and how we round on them.